Washington Health Benefit Exchange HEALTHPLANFINDER BUSINESS SHOP TAC

Washington Health Benefit Exchange HEALTHPLANFINDER BUSINESS (SHOP) TAC NOVEMBER 12, 2015

PACE ACT ▪ “Protecting Affordable Coverage for Employees Act” (PACE) ▪ Amendment to the Affordable Care Act, passed by Congress and signed by the President this fall. ▪ Changes the number of employees eligible for small group coverage from 100 to 50 starting in 2016. ▪ ACA change in small group definition to 100 was slated to go in to effect 1/1/2016. ▪ This and other ACA mandates take place for coverage starting January 2016 2

2016 CHANGES ▪ Federal definition of eligible employees ▪ FTEs vs. employees (bodies) ▪ Full-time employee = 30 hours or more per week ▪ Calculation = Actual FTEs + sum of hours of non-FTEs divided by 120 ▪ Used to determine whether a group is a small vs a large group ▪ Employers will need to attest to their eligibility during the application process ▪ All FT employees must be offered coverage in order to apply for coverage in WA Healthplanfinder Business 3

2016 CHANGES ▪ Federal definition of an eligible group includes that a group must have at least one common law employee along with the employer ▪ We will no longer be able to offer coverage to sole proprietors beginning in 2016 ▪ Five sole proprietors are currently enrolled ▪ HBE will inform each enrolled individual at the time of their renewal ▪ Outside of the SHOP marketplace (state-based or federallybased), the method of counting eligible employees may differ from inside SHOP 4

QUESTIONS ? ? 5

2016 CHANGES ▪ Moda Health is exiting the WA market in both individual and small group & fully-insured large group ▪ WA Healthplanfinder Business ▪ 30 plans to be offered instead of 47 ▪ United Healthcare of WA will provide statewide enrollment ▪ Kaiser Permanente – Clark & Cowlitz counties ▪ HBE is working closely with Moda to inform all customers and brokers of the change 6

COMMITTEE MEMBERS -- UPDATE ▪ Kelly Allen, Kelly Allen Insurance ▪ Insurance broker, small business owner ▪ Lonnie Goodell, Group Health Cooperative ▪ Director, Small Business Group & Producer Relations ▪ Paul Hofmann, Attorney’s Title of Kitsap ▪ Owner/President ▪ Troy Nordlund, Pacific NW Insurance Brokerage, Inc. ▪ Insurance broker 7